Vice President, Claims & Risk

Overview

PRIMARY PURPOSE

• Responsible for implementing and maintaining best-in-class Claims and Risk Department that fully aligns with the organization's overall vision, mission and strategy.
• Coordinate and implement strategic initiatives designed to reduce the financial impact on the organization.
• Provide strategic leadership for the Claims and Risk program enterprise wide.
• Approach claims and risk at an enterprise level and collaborate effectively across the organization to deliver top-decile results, lead transformation initiatives, and support the teammates who deliver patient care.

MAJOR RESPONSIBILITIES

• Leadership and mentoring of a Claims and Risk team; establishing clear performance metrics, implementing strong policies and procedures designed to produce the desired results.
• Assist in the development of an inclusive strategic plan and long-term vision for the claims and risk department by collaborating with key stakeholders and senior leadership team.
• Develops and recommends operating and capital budgets and controls expenditures.
• Demonstrate the highest standards of leadership to ensure engagement, performance, accountability and achievement of department goals aligning with enterprise objectives.
• Evaluate, assess, and evolve data analytics for improved claims and risk management, reporting and trend analysis.
• Ensure strategies align with the organizational vision, mission and values while providing direction and oversight to the enterprise function.
• Ensure alignment with laws, rules, and regulations for each venue.
• Lead and oversee the process for the establishment of sound, timely and reliable indemnity and expense reserves. This includes authority over the resolution of claims and lawsuits pursuant to department guidelines and authority levels established by Risk Management procedures and the Advocate Financial Control Policy; establishing and ensuring compliance to standards for all indemnity and expense reserves; overseeing the creation of routine claims and litigation reports for site and system stakeholders including EMT and senior leadership; oversee the creations and routine review of all reserving guidelines, claims policies and procedures, forms, processes and management structure for handling liability matters.
• Addresses health outcomes, risk identification, loss prevention, and claims management to improve the quality of patient care; prevents, mitigates and/or reduces risk of potential and actual financial, physical and reputational loss. Participates in system health outcomes goals and strategic plan development, implementation and measurement including provision of data and recommendation within the system. Participates in system level safety huddles; conduct weekly risk huddles with all site risk directors and managers. Identifies, in conjunction with site and other departments, high risk areas requiring proactive risk assessments. Coordinates resources to achieve review, findings and action plan. Presents results to applicable groups. Develops goals and plans through multiple internal data sources including the complaint and event reporting system, claims, write-offs, risk and quality assessments, recalls; and external sources such as literature evidence- based practice, and alerts from national and international sources.
• Maintains adverse event reporting, investigation, and resolution process. Participates in web-based reporting design, access, training and implementation. Reviews and tracks reported events. Leads and/or participates in root cause analysis review. Maintains and improves process to identify significant events and notify appropriate system and site executives, patient safety, legal, compliance, safety/security, and media relations.
• Develop and maintain relationships with litigation vendors, jury consultants and alternative attorney billing arrangements to control litigation expenses; Establish and review annually attorney rates for all law firm.
• Responsible for the selection of Claims and Risk Management Information/Claim technology, defense counsel, vendor partners, consultants, as related to specific assignment.
• Participate in committees as assigned and/or needed.
• Other duties as assigned.

SUPERVISORY/MANAGEMENT RESPONSIBILITIES

• Leadership, mentoring and evaluation of leaders in the claims and risk team.
• In conjunction with leaders, will manage teammates including performance evaluations, approve/recommend hiring, termination, promotion/demotion, pay decisions, discipline/corrective action, budget development/accountability.
• Evaluate and approve settlements as outlined in the financial approval policy.

MINIMUM EDUCATION AND EXPERIENCE REQUIRED

Level of Education: Master's Degree

Years of Experience: 15+ years of experience in risk and claims, experience in healthcare required. Prefer experience in self-insured, self-administered environment.

Experience: Advanced knowledge of the insurance industry, claims, and the insurance legal, compliance, and regulatory environment. Possess the ability to process and adapt to change in a rapid growth environment.

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES (KSA)

• Developed problem-solving, analytical, and decision-making skills.
• Experienced in collaborating with an executive team.
• Proven ability to improve organizational effectiveness as well as retain, hire, train, mentor and develop claims and risk professionals.
• Strong people skills, and ability to communicate and manage well at all levels of the organization are essential.
• Elevated level of integrity and dependability with a keen sense of urgency and results oriented.
• Extensive experience in progressive positions demonstrating technical, operations, and management skills in the claims and risk area.
• Deep understanding of organizational Risk Management and the intersections both internally and externally.
• Proven ability to work independently as well as in a team environment.
• Understanding of Risk Management Information Systems (RMIS) is essential.
• Proficiency with Microsoft Office Products

PHYSICAL REQUIREMENTS AND WORKING CONDITIONS

• This position requires travel, therefore, will be exposed to weather and road conditions.
• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment; some standing and walking is required.
• Must demonstrate the ability to communicate and concentrate effectively.
• Good hearing is required for related communications.